Provider Demographics
NPI:1285721415
Name:JAIME B YAMAT MDSC
Entity type:Organization
Organization Name:JAIME B YAMAT MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:B
Authorized Official - Last Name:YAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-384-2700
Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-2937
Practice Address - Street 1:10200 W INNOVATION DR STE 700
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4827
Practice Address - Country:US
Practice Address - Phone:414-302-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30896100Medicaid
WI000001555Medicare PIN